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Background and purpose Methods Results Conclusions The impact of bridging thrombolysis prior to endovascular thrombectomy (EVT) compared to EVT alone on intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH), and death in anticoagulated atrial fibrillation (AF) patients with acute ischaemic stroke (AIS) is not well defined.A retrospective study was conducted using data from a federated research network (TriNetX) including 114 health care organisations in the United States. Anticoagulated AF patients with AIS who received either bridging thrombolysis (BT) or EVT alone from September 2018 to November 2023 were included. Following propensity score matching, Cox regression analyses examined the risk of ICH, SAH, and death within 30 and 90 days, comparing anticoagulated AF patients receiving BT versus EVT only.A total of 3156 patients with AIS were treated with BT or EVT alone. Following 1:1 propensity score matching, the cohort included 766 patients in each group. ICH occurred within 30 and 90 days in 6.9% and 8.0% in the BT group compared with 7.4% and 7.7% in the EVT‐only group (hazard ratios [HR] = 0.92, 95% confidence interval [CI] = 0.63–1.33 and HR = 1.01, 95% CI = 0.71–1.45, respectively). SAH occurred within 30 and 90 days in 4.2% and 4.4% of patients in the BT compared to 3.0% and 3.4% in the EVT‐only group (HR = 1.38, 95% CI = 0.81–2.38 and HR = 1.29, 95% CI = 0.77–2.14, respectively). Death occurred within 30 and 90 days in 17.8% and 19.8% of patients in the BT compared to 22.2% and 27.3% in the EVT‐only group (HR = 0.77, 95% CI = 0.62–0.97 and HR = 0.65, 95% CI = 0.56–0.86, respectively).In anticoagulated AF patients with AIS, BT was associated with a significantly lower risk of death, with no difference in ICH or SAH risk within 30 and 90 days compared to EVT only. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) has consistently been associated with a higher risk of incident dementia. Observational evidence has suggested catheter ablation may be associated with a lower risk of dementia in patients with AF, but further research is needed. The objectives of this study were to use a global health research network to examine associations between catheter ablation, incident dementia and mortality in older adults with AF, and amongst subgroups by age, sex, co‐morbidity status, and oral anticoagulant use. Methods: The research network primarily included healthcare organizations in the United States. This network was searched on 28th September 2022 for patients aged ≥65 years with a diagnosis of AF received at least 5 years prior to the search date. Cox proportional hazard models were run on propensity‐score matched cohorts. Results: After propensity score matching, 20,746 participants (mean age 68 years; 59% male) were included in each cohort with and without catheter ablation. The cohorts were well balanced for age, sex, ethnicity, co‐morbidities, and cardiovascular medications received. The risk of dementia was significantly lower in the catheter ablation cohort (Hazard Ratio 0.52, 95% confidence interval: 0.45–0.61). The catheter ablation cohort also had a lower risk of all‐cause mortality (Hazard Ratio 0.58, 95% confidence interval: 0.55–0.61). These associations remained in subgroup analyses in individuals aged 65–79 years, ≥80 years, males, females, participants who received OACs during follow‐up, participants with paroxysmal and non‐paroxysmal AF, and participants with and without hypertension, diabetes mellitus, ischemic stroke, chronic kidney disease and heart failure, including heart failure with preserved ejection fraction and heart failure with reduced ejection fraction. Conclusion: The observed lower risk of dementia and mortality with catheter ablation could be an important consideration when determining appropriate patient‐centered rhythm control strategies for patients with AF. Further studies including data on the success of ablation are required. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) associates with higher Alzheimer's disease (AD) and vascular dementia risks but the clinical implications have been scarcely investigated. We examined the association between AD or vascular dementia and adverse outcomes in AF patients. Methods: Cohort study between January 2000 and 2017. AF patients were divided into two groups according to vascular dementia or AD, and balanced using propensity score matching (PSM). During 4‐years of follow‐up, incident intracranial hemorrhages (ICH), the composite of ischemic stroke/transient ischemic attack (TIA), hospitalizations, and all‐cause deaths, were recorded. Results: Two thousand three hundred seventy‐seven AF patients with dementia (1225 with vascular dementia, and 1152 with AD) were identified. Following a PSM, 615 patients were included in each cohort (i.e., 1:1) and all variables were well‐matched. After PSM, 22 (3.6%) patients with vascular dementia and 55 (8.1%) patients with AD had incident ICH during follow‐up (hazard ratio [HR]: 2.22, 95% confidence interval [CI]: 1.33−3.70, log‐rank p = 0.002). Overall, 237 (38.5%) patients with vascular dementia and 193 (31.4%) patients with AD, developed an ischemic stroke/TIA. The risk of ischemic stroke/TIA was 1.32‐fold higher in vascular dementia (HR: 1.32, 95% CI: 1.09−1.59, log‐rank p = 0.003). The risk of rehospitalization (HR: 1.14, 95% CI: 1.01−1.31), and mortality (HR: 1.25, 95% CI: 1.01−1.58) were also higher among AF patients with vascular dementia compared to AD. Conclusions: The two forms of dementia in AF patients are associated with different prognosis, with AD being associated with a higher risk of ICH, and vascular dementia with a higher risk of stroke/TIA, hospitalization, and mortality. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to determine associations between use of oral anticoagulation (OAC) and stroke and bleeding‐related outcomes for older people ≥80 years with atrial fibrillation (AF), and to determine trends over time in prescribing of OAC for this population. Methods: A retrospective cohort study was conducted. People aged ≥80 years with AF receiving (1) no OAC; (2) warfarin; or (3) a non‐vitamin‐K antagonist oral anticoagulant (NOAC) between 2011 and 2019 were included. Propensity score matching was used to balance cohorts (no OAC, warfarin or a NOAC) on characteristics including age, sex, ethnicity, and co‐morbidities. Cox proportional hazard models were used to derive hazard ratios (HRs) and 95% confidence intervals (CIs). Results: The proportion of people aged ≥80 years receiving any OAC increased from 32.4% (n = 27,647) in 2011 to 43.6% (n = 110,412) in 2019. After propensity score matching, n = 169,067 individuals were included in the cohorts receiving no OAC or a NOAC. Compared to no OAC, participants receiving a NOAC had a lower risk of incident dementia (hazHR 0.68, 95% CI 0.65–0.71), all‐cause mortality (HR 0.49, 95% CI 0.48–0.50), first‐time ischaemic stroke (HR 0.87, 95% CI 0.83–0.91), and a higher risk of major bleeding (HR 1.08, 95% CI 1.05–1.11). Compared to participants receiving warfarin, participants receiving a NOAC had a lower risk of dementia (HR 0.90, 95% CI: 0.86–0.93), all‐cause mortality (HR 0.74, 95% CI: 0.72–0.76), ischaemic stroke (HR 0.86, 95% CI: 0.82–0.90) and major bleeding (HR 0.88, 95% CI: 0.85–0.90). Similar results were observed when only including people with additional bleeding risk factors. Conclusions: The proportion of people aged ≥80 years receiving OAC has increased since the introduction of NOACs, but remains low. Use of a NOAC was associated with improved outcomes compared to warfarin, and compared to no OAC, except for a small but statistically significant higher risk of major bleeding. [ABSTRACT FROM AUTHOR]

Background: COVID‐19 has a wide spectrum of cardiovascular sequelae including myocarditis and pericarditis; however, the prevalence and clinical impact are unclear. We investigated the prevalence of new‐onset myocarditis/pericarditis and associated adverse cardiovascular events in patients with COVID‐19. Methods and results: A retrospective cohort study was conducted using electronic medical records from a global federated health research network. Patients were included based on a diagnosis of COVID‐19 and new‐onset myocarditis or pericarditis. Patients with COVID‐19 and myocarditis/pericarditis were 1:1 propensity score matched for age, sex, race and comorbidities to patients with COVID‐19 but without myocarditis/pericarditis. The outcomes of interest were 6‐month all‐cause mortality, hospitalisation, cardiac arrest, incident heart failure, incident atrial fibrillation and acute myocardial infarction, comparing patients with and without myocarditis/pericarditis. Of 718,365 patients with COVID‐19, 35,820 (5.0%) developed new‐onset myocarditis and 10,706 (1.5%) developed new‐onset pericarditis. Six‐month all‐cause mortality was 3.9% (n = 702) in patients with myocarditis and 2.9% (n = 523) in matched controls (p <.0001), odds ratio 1.36 (95% confidence interval (CI): 1.21–1.53). Six‐month all‐cause mortality was 15.5% (n = 816) for pericarditis and 6.7% (n = 356) in matched controls (p <.0001), odds ratio 2.55 (95% CI: 2.24–2.91). Receiving critical care was associated with significantly higher odds of mortality for patients with myocarditis and pericarditis. Patients with pericarditis seemed to associate with more new‐onset cardiovascular sequelae than those with myocarditis. This finding was consistent when looking at pre‐COVID‐19 data with pneumonia patients. Conclusions: Patients with COVID‐19 who present with myocarditis/pericarditis associate with increased odds of major adverse events and new‐onset cardiovascular sequelae. [ABSTRACT FROM AUTHOR]

This editorial comments on the article by Mailhot et al. [ABSTRACT FROM AUTHOR]

Background: There are limited data on the outcomes of adults with coronavirus disease 2019 (COVID‐19) and atrial fibrillation (AF). The objectives were to (i) examine associations between AF, 30‐day thromboembolic events and mortality in adults with COVID‐19 and (ii) examine associations between COVID‐19, 30‐day thromboembolic events and mortality in adults with AF. Methods: A study was conducted using a global federated health research network. Adults aged ≥50 years who presented to 41 participating healthcare organizations between 20 January 2020 and 1 September 2020 with COVID‐19 were included. Results: For the first objective, 6589 adults with COVID‐19 and AF were propensity score matched for age, gender, race, and comorbidities to 6589 adults with COVID‐19 without AF. The survival probability was significantly lower in adults with COVID‐19 and AF compared to matched adults without AF (82.7% compared to 88.3%, Log‐Rank test P <.0001; Risk Ratio (95% confidence interval) 1.61 (1.46, 1.78)) and risk of thromboembolic events was higher in patients with AF (9.9% vs 7.0%, Log‐Rank test P <.0001; Risk Ratio (95% confidence interval) 1.41 (1.26, 1.59)). For the second objective, 2454 adults with AF and COVID‐19 were propensity score matched to 2454 adults with AF without COVID‐19. The survival probability was significantly lower for adults with AF and COVID‐19 compared to adults with AF without COVID‐19, but there was no significant difference in risk of thromboembolic events. Conclusions: AF could be an important risk factor for short‐term mortality with COVID‐19, and COVID‐19 may increase risk of short‐term mortality amongst adults with AF. [ABSTRACT FROM AUTHOR]

Objective: To examine the prevalence of psychotropic medicine dispensing before and after older people enter residential care.Design: Retrospective national cohort study; analysis of Registry of Senior Australians (ROSA) data.Setting, Participants: All concession card-holding residents of government-subsidised residential aged care facilities in Australia who entered residential care for at least three months between 1 April 2008 and 30 June 2015.Main Outcome Measures: Proportions of residents dispensed antipsychotic, benzodiazepine, or antidepressant medicines during the year preceding and the year after commencing residential care, by quarter.Results: Of 322 120 included aged care residents, 68 483 received at least one antipsychotic (21.3%; 95% CI, 21.1-21.4%), 98 315 at least one benzodiazepine (30.5%; 95% CI, 30.4-30.7%), and 122 224 residents at least one antidepressant (37.9%; 95% CI, 37.8-38.1%) during their first three months of residential care; 31 326 of those dispensed antipsychotics (45.7%), 38 529 of those dispensed benzodiazepines (39.2%), and 25 259 residents dispensed antidepressants (19.8%) had not received them in the year preceding their entry into care. During the first three months of residential care, the prevalence of antipsychotic (prevalence ratio [PR], 3.37; 95% CI, 3.31-3.43) and antidepressant dispensing (PR, 1.05; 95% CI, 1.04-1.07) were each higher for residents with than for those without dementia; benzodiazepine dispensing was similar for both groups (PR, 1.01; 95% CI, 0.99-1.02).Conclusions: Dispensing of psychotropic medicines to older Australians is high before they enter residential care but increases markedly soon after entry into care. Non-pharmacological behavioural management strategies are important for limiting the prescribing of psychotropic medicines for older people in the community or in residential care. [ABSTRACT FROM AUTHOR]

Objective: A clustered domestic model of residential aged care has been associated with better consumer‐rated quality of care. Our objective was to examine differences in staffing structures between clustered domestic and standard models. Methods: A cross‐sectional study involving 541 individuals living in 17 Australian not‐for‐profit residential aged care homes. Results: Four of the homes offered dementia‐specific clustered domestic models of care with higher personal care attendant (PCA) hours‐per‐resident‐per‐day (mean [SD] 2.43 [0.29] vs. 1.74 [0.46], P < 0.001), slightly higher direct care hours‐per‐resident‐per‐day (2.66 [0.35] vs. 2.58 [0.44], P = 0.006), higher staff training costs ($1492 [258] vs. $989 [928], P < 0.001) and lower registered/enrolled nurse hours‐per‐resident‐per‐day (0.23 [0.10] vs. 0.85 [0.17], P < 0.001) compared to standard models. Conclusions: An Australian clustered domestic model of care had higher PCA hours, more staff training and more direct care time compared to standard models. Further research to determine optimal staffing structures within alternative models of care is warranted. [ABSTRACT FROM AUTHOR]

Background: Current information on the patterns of medication use in nursing home residents living with dementia is conflicting. Aim: The aim of this study was to investigate medication use and its associations with dementia diagnosis in Australian nursing home residents. Methods: A cross‐sectional study of 541 residents from 17 Australian nursing homes was performed. Results: Over 12 months, nursing home residents were prescribed a mean (±SD) of 14.5 ± 6.8 medications each. Approximately 95% of residents were prescribed medications for the nervous system, and 94% were prescribed medications for the alimentary tract and metabolism. After adjustment for potential confounders, those with dementia were less likely to be prescribed medications for the cardiovascular system (odds ratio (OR) 0.45, 95% confidence interval (CI) 0.27–0.77, p = 0.0032) and respiratory system (OR 0.38, 95% CI: 0.25–0.60, p < 0.0001). Further analysis of specific medications showed that residents with dementia were more likely to be prescribed risperidone (OR: 9.38, 95% CI: 4.01–21.94, p < 0.0001), buprenorphine (OR 3.37, 95% CI: 1.78–6.36, p = 0.0002) and trimethoprim (OR 1.78, 95% CI: 1.06–2.97, p = 0.0282), but less likely to be prescribed glyceryl trinitrate (OR 0.42, 95% CI: 0.19–0.94, p = 0.0340) and salbutamol (OR 0.34, 95% CI: 0.2–0.6, p = 0.0002) in addition to other specific medications. Conclusions: Increased awareness of possible undertreatment of cardiovascular and respiratory conditions, and possible overtreatment of urinary tract infection, in those living with dementia in nursing home settings may improve management of this vulnerable population. [ABSTRACT FROM AUTHOR]

Objectives: This analysis estimates the whole-of-system direct costs for people living with dementia in residential care by using a broad health and social care provision perspective and compares it to people without dementia living in residential care.Methods: Data were collected from 541 individuals living permanently in 17 care facilities across Australia. The annual cost of health and residential care was determined by using individual resource use data and reported by the dementia status of the individuals.Results: The average annual whole-of-system cost for people living with dementia in residential care was approximately AU$88 000 (US$ 67 100) per person in 2016. The cost of residential care constituted 93% of the total costs. The direct health care costs were comprised mainly of hospital admissions (48%), pharmaceuticals (31%) and out-of-hospital attendances (15%). While total costs were not significantly different between those with and without dementia, the cost of residential care was significantly higher and the cost of health care was significantly lower for people living with dementia.Conclusion: This study provides the first estimate of the whole-of-system costs of providing health and residential care for people living with dementia in residential aged care in Australia using individual level health and social care data. This predominantly bottom-up cost estimate indicates the high cost associated with caring for people with dementia living permanently in residential care, which is underestimated when limited cost perspectives or top-down, population costing approaches are taken. [ABSTRACT FROM AUTHOR]

Objective: To compare the outcomes and costs of clustered domestic and standard Australian models of residential aged care.Design: Cross-sectional retrospective analysis of linked health service data, January 2015 - February 2016.Setting: 17 aged care facilities in four Australian states providing clustered (four) or standard Australian (13) models of residential aged care.Participants: People with or without cognitive impairment residing in a residential aged care facility (RACF) for at least 12 months, not in palliative care, with a family member willing to participate on their behalf if required. 901 residents were eligible; 541 consented to participation (24% self-consent, 76% proxy consent).Main Outcome Measures: Quality of life (measured with EQ-5D-5L); medical service use; health and residential care costs.Results: After adjusting for patient- and facility-level factors, individuals residing in clustered models of care had better quality of life (adjusted mean EQ-5D-5L score difference, 0.107; 95% CI, 0.028-0.186; P = 0.008), lower hospitalisation rates (adjusted rate ratio, 0.32; 95% CI, 0.13-0.79; P = 0.010), and lower emergency department presentation rates (adjusted rate ratio, 0.27; 95% CI, 0.14-0.53; P < 0.001) than residents of standard care facilities. Unadjusted facility running costs were similar for the two models, but, after adjusting for resident- and facility-related factors, it was estimated that overall there is a saving of $12 962 (2016 values; 95% CI, $11 092-14 831) per person per year in residential care costs.Conclusions: Clustered domestic models of residential care are associated with better quality of life and fewer hospitalisations for residents, without increasing whole of system costs. [ABSTRACT FROM AUTHOR]

Objectives To examine the Framingham Stroke Risk Profile (FSRP); the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) risk score, and oxi-inflammatory load (cumulative risk score of three blood biomarkers-homocysteine, interleukin-6, C-reactive protein) for associations with cognitive decline using three cohort studies of very old adults and to examine whether incorporating these biomarkers with the risk scores can affect the association with cognitive decline. Design Three longitudinal, population-based cohort studies. Setting Newcastle-upon-Tyne, United Kingdom; Leiden, the Netherlands; and Lakes and Bay of Plenty District Health Board areas, New Zealand. Participants Newcastle 85+ Study participants (n = 616), Leiden 85-plus Study participants (n = 444), and Life and Living in Advanced Age, a Cohort Study in New Zealand (Li LACS NZ Study) participants (n = 396). Measurements FSRP, CAIDE risk score, oxi-inflammatory load, FSRP incorporating oxi-inflammatory load, and CAIDE risk score incorporating oxi-inflammatory load. Oxi-inflammatory load could be calculated only in the Newcastle 85+ and the Leiden 85-plus studies. Measures of global cognitive function were available for all three data sets. Domain-specific measures were available for the Newcastle 85+ and the Leiden 85-plus studies. Results Meta-analysis of pooled results showed greater risk of incident global cognitive impairment with higher FSRP (hazard ratio ( HR) = 1.46, 95% confidence interval (CI) = 1.08-1.98), CAIDE (HR = 1.53, 95% CI = 1.09-2.14), and oxi-inflammatory load (HR = 1.73, 95% CI = 1.04-2.88) scores. Adding oxi-inflammatory load to the risk scores increased the risk of cognitive impairment for the FSRP (HR = 1.65, 95% CI = 1.17-2.33) and the CAIDE model (HR = 1.93, 95% CI = 1.39-2.67). Conclusion Adding oxi-inflammatory load to cardiovascular risk scores may be useful for determining risk of cognitive impairment in very old adults. [ABSTRACT FROM AUTHOR]

Objectives To determine, using data from the Newcastle 85+ Study, whether there is an association between modern diagnostic criteria for metabolic syndrome (MetS) and cognitive function in very old adults (≥85) and whether inflammation, physical activity, or diabetes mellitus status affects this association. Design Longitudinal, population-based cohort study. Setting Newcastle and North Tyneside, United Kingdom. Participants Community-dwelling and institutionalized men and women recruited through general practices (N = 845). Measurements MetS was defined according to the National Cholesterol Education Program ( NCEP) Adult Treatment Panel III ( ATP III) criteria. Cross-sectional and prospective (up to 5 years of follow-up) associations between MetS and global cognitive function (assessed using the Mini-Mental State Examination ( MMSE)) and between MetS and attention and episodic memory (assessed using the Cognitive Drug Research battery) were performed. Results MetS was not associated with cognitive function at baseline or cognitive change over time. Lack of association was not because MetS was predictive of subsequent mortality. Of the individual components of the MetS criteria, high blood pressure was associated with better cognitive function at baseline ( MMSE: β (standard error ( SE)) = −0.716 (0.152), P < .001), and low high-density lipoprotein cholesterol was associated with poorer global cognitive function at baseline ( MMSE: 0.436 (0.131), P = .001). Conclusion The association between MetS and cognitive decline, which has been described in younger populations (<75), was not apparent in this population of individuals aged 85 and older at baseline. [ABSTRACT FROM AUTHOR]

Objectives To determine the association between objectively measured physical activity ( PA), fractures, and falls. Design Longitudinal cohort study. Setting Six U. S. clinical sites. Participants Two thousand seven hundred thirty-one men with a mean age of 79. Measurements Total and active energy expenditure ( EE) and minutes per day spent in sedentary and moderate intensity activities were measured for at least 5 days. Energy expended at a metabolic equivalent of greater than three was termed active EE. Incident nonspine fractures and falls were identified every 4 months. Results Seven hundred fifty-nine (28.2%) men fell at least once over 12 months of follow-up; 186 (6.8%) experienced one or more fractures over an average follow-up of 3.5 ± 0.9 years. The association between PA and falling varied according to age ( P interaction = .02). Men younger than 80 with the lowest active EE had a lower risk of falling than men with the highest active EE (relative risk ( RR) = 0.75; P trend = .08), whereas men aged 80 and older with the lowest active EE had a higher risk of falling than men with the highest active EE ( RR = 1.43, P trend = .09). In multivariate models including health status, men in the lowest quintile of active EE had a significantly higher risk of fracture (hazard ratio ( HR) = 1.82, 95% confidence interval ( CI) = 1.10-3.00, P trend = .04) than men in highest quintile. Men with <33 min/d of moderate activity had a 70% greater risk of fracture ( HR = 1.70, 95% CI = 1.03-2.80). Conclusion Age modifies the association between PA and falling. Interventions aimed at obtaining more than 30 minutes of moderate PA per day may reduce fractures, extending PA guidelines to the oldest old, the fastest-growing proportion of those aged 65 and older. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine the association between alcohol intake and problem drinking history and bone mineral density (BMD), falls and fracture risk. DESIGN: Cross-sectional and prospective cohort study. SETTING: Six U.S. clinical centers. PARTICIPANTS: Five thousand nine hundred seventy-four men aged 65 and older. MEASUREMENTS: Alcohol intake and problem drinking histories were ascertained at baseline. Follow-up time was 1 year for falls and a mean of 3.65 years for fractures. RESULTS: Two thousand one hundred twenty-one participants (35.5%) reported limited alcohol intake (<12 drinks/y); 3,156 (52.8%) reported light intake (<14 drinks/wk), and 697 (11.7%) reported moderate to heavy intake (≥14 drinks/wk) in the year before baseline. One thousand one men (16.8%) had ever had problem drinking. In multivariate models, as alcohol intake increased, so did hip and spine BMD ( P for trend <.001). Greater alcohol intake was not associated with greater risk for nonspine or hip fractures. Men with light intake, but not moderate to heavy intake, had a lower risk of two or more incident falls (light intake: relative risk (RR)=0.77, 95% confidence interval (CI)=0.65–0.92; moderate to heavy intake: RR=0.83, 95% CI=0.63–1.10) than abstainers. Men with problem drinking had higher femoral neck (+1.3%) and spine BMD (+1.4%), and a higher risk of two or more falls (RR=1.59; 95% CI=1.30–1.94) than those without a history of problem drinking and similar total hip BMD and risk of fracture. CONCLUSION: In older men, recent alcohol intake is associated with higher BMD. Alcohol intake and fracture risk is unclear. Light alcohol intake may decrease the risk of falling, but a history of problem drinking increased fall risk. [ABSTRACT FROM AUTHOR]